Active Employees Health Insurance Information

Anthem Blue Cross EPO, EPO 500, or EPO 1000

EPOs, or Exclusive Provider Organizations, are copay based and only cover services performed solely by providers within their network (with the exception of emergency services). On this plan, you may self-refer to in-network specialists.

• Medical and mental health coverage is through Anthem Blue Cross.
• Prescription coverage is through EmpiRx.
• Vision coverage is through the Vision Service Plan (VSP).

Anthem Blue Cross PPO 250

PPOs, or Preferred Provider Organizations, allow you to use out-of-network providers, but at a higher rate. The deductible period for this PPO plan is for the plan year, starting December 12, 2022.

• Medical and mental health coverage is through Anthem Blue Cross.
• Prescription coverage is through EmpiRx.
• Vision coverage is through the Vision Service Plan (VSP).

Anthem Blue Cross HDPPO 3000

HDPPOs, or High Deductible Preferred Provider Organizations, have high deductibles and low premiums. As with other PPO plans, they allow you to use out-of-network providers, but at a higher rate. The deductible period for this HDPPO plans is based on the calendar year, starting January 1, 2023.

• Medical, mental health, and prescription coverage is through Anthem Blue Cross.
• Vision coverage is through Vision Service Plan (VSP).

Is Your Doctor In the Anthem Network?

Visit Anthem’s Website today and follow this pathway:

1. Providers > Provider Resources > Find a Doctor
2. From here, you can search as member or search as guest.
   • How do you get insurance? Through my employer
   • What state do you want to search in? Choose the State
   • What type of care are you searching for? Medical
   • Select a plan/network: EPO (it should be about 6 down on the list)
3. Finally, use the search engine to look for your doctor!

Notice of Direct Contract between SJVIA and CMC

Community Health System has entered into a direct contract with San Joaquin Valley Insurance Authority (SJVIA), a joint powers authority between the County of Fresno and County of Tulare where health insurance is purchased.

This direct contract means that SJVIA members, including County of Fresno employees, can receive services provided at Community Medical Centers’ hospitals and Community Health Partners’ practices at in network rates and will be retro-active to January 1, 2023.

What do I need to do to access services?

Provide your County of Fresno Anthem card when accessing services. Provider locations will confirm members are covered under this new agreement by looking at the Group Number prefix – 275341. CMC physicians were made aware of the direct contract and have been advised on how to confirm coverage; letter is linked below.

County of Fresno – Human Resources, Employee Benefits would like to thank the SJVIA for their efforts in putting this direct contract in place while Anthem and Community Health System continue to negotiate towards an agreement.

SJVIA Direct Contract Announcement to Providers(PDF, 82KB)

Kaiser Permanente HMO

HMOs, or Health Maintenance Organizations, are copay based and cover services performed solely by providers within their network (with the exception of emergency services).

• Medical, mental health, prescription, and vision coverage are all through Kaiser Permanente.

Delta Dental DPPO

PPOs, or Preferred Provider Organizations, allow you to use out-of-network providers, but at a higher rate. The deductible period for this PPO plan is based on the calendar year.

DeltaCare USA DHMO

HMOs, or Health Maintenance Organizations, are copay based and cover services performed solely by providers within their network (with the exception of emergency services).

Dental Plan Option Comparison Chart

Visit deltadentalins.com to search for an in-network provider.

Employees experiencing a qualifying life event outside of the Open Enrollment period have thirty (30) days from the event date to turn in the required forms and supplemental documentation to Employee Benefits. Applicable changes may include enrollment or opting out of County health insurance coverage, enrolling or removing dependents, and changing your plan options during those instances. For more information please visit the Qualifying Events & Changes Permitted page, or contact Employee Benefits for clarification.

Please visit the Employee Benefits forms page to obtain necessary forms for any applicable qualifying life event.

Please note, Employee Benefits is not responsible for lost/delayed forms sent through the mail and therefore not received by the deadline. To confirm receipt of forms and/or supporting documentation, please contact Employee Benefits.

Opt Outs - Gaining Other Coverage Mid Plan Year

If you newly gain group medical health insurance coverage throughout the plan year, you will be eligible to opt out (waive) the County health insurance benefits. To opt out, please complete the 2023 Opt Out Form (Qualifying Events), and submit proof (subject to Employee Benefits approval) as detailed below. You can obtain the form on the Forms page or by contacting Employee Benefits.

Opt Out Qualifying Events Submission Deadline: 30 days from the date your other qualifying coverage becomes effective. Because the County of Fresno health benefit eligibility is on a bi-weekly basis, your opt out status will become effective beginning the pay period immediately following the effective date of your coverage.

Proof submitted must be:

1. Current - You must submit recent proof that shows your enrollment will become active under the other plan.
2. Employer-Sponsored Plan - Acceptable coverage includes, but is not limited to, other and former employer provided coverage or coverage obtained through a spouse’s employer. Medi-cal/Medicaid and individual policies are not eligible health plans to opt out of the County health insurance. However, employees under the age of 26 may opt out under a parent’s insurance policy, regardless of the type of policy.
3. Written - Acceptable documentation of proof of coverage must include your name (employee name) and the date your other coverage becomes effective, and are provided as one of the following:
   • A copy of your insurance card with your name reflected. If your insurance card does not have your name shown, you must provide additional documentation showing you listed as a dependent of the individual listed on the card
   • A letter, HIPAA certificate, or screenshot from the health insurance company
   • A letter, HIPAA certificate, or screenshot from the health plan administrator
   • A letter or screenshot from the employer providing the coverage